Return of Spontaneous Circulation (ROSC) Medical Directive

Question 1

ROSC MD

What are the indications?

Answer 1

Patient with return of spontaneous circulation (ROSC) after the resuscitation was initiated.

Question 2

ROSC MD

What are the conditions for a 0.9% NaCl Fluid Bolus?

Answer 2

Age ≥2 years
SBP - Hypotension
Other - Chest auscultation is
clear

Question 3

ROSC MD

What are the contraindications for a 0.9% NaCl Fluid Bolus?

Answer 3

Fluid bolus.

Question 4

ROSC MD

What is the order of treatment?

Answer 4

1. Consider optimizing ventilation and oxygenation
2. Consider 0.9% NaCl fluid bolus (if available and authorized)
3. Consider 12-lead ECG acquisition and interpretation
   4.

Question 5

ROSC MD

What should you titrate oxygenation to?

Answer 5

94-98%

Question 6

ROSC MD

What should we do/consider for ETCO2?

Answer 6

Avoid hyperventilation and target ETCO2 to 30-40 mmHg with continuous waveform
capnography (if available).

Question 7

ROSC MD

What is the bolus for patients who are ≥2 years to <12 years old?

Answer 7

10 ml/kg, immediate. Reassess every 100 ml, max 1000 ml.

Question 8

ROSC MD

What is the bolus for patients who are ≥12 years old?

Answer 8

10 ml/kg, immediate. Reassess every 250 ml, max 1000 ml.

Question 9

ROSC MD

What are the clinical considerations?

Answer 9

• Consider initiating transport in parallel with the above treatment.
• IV fluid bolus applies only to PCPs authorized for PCP Autonomous IV.